Longitudinal Parallel Compression Suture To Control PPH Due to Placenta Previa & Accreta.

Abstract

Objective:  To determine the efficacy and safety of longitudinal parallel compression sutures to control postpartum haemorrhage (PPH) in placenta previa/accreta patients.

Methodology: This cross-sectional study was conducted at Department of obstetrics and gynaecology, Peoples University of Medical & Health Sciences for Women; Nawab shah for a period of six months from 7^th June 2023 to 6^th Dec 2023, after getting approval from ERB of People University of Medical & Health Science. Sample size achieved through non-probability consecutive sampling. Women fulfilling inclusion criteria were selected from the operation theatre of Obstetrics & Gynaecology, PUMHS Nawabshah. To control life threatening PPH owing to placenta previa (with or without accreta) during caesarean section, longitudinal parallel compression sutures in operating room. Outcome variables observed includes amount of blood loss, number of days stayed in the hospital, need for concurrent procedure, need of hysterectomy, and maternal death. Data was entered and analysed on SPSS 25.

Results:

The stitch was applied in 31 patients. The technique was effective, and successful as a single procedure in 11 patients (35.43%). 6 patients (19%) needed additional tamponade; 12 patients (38%) also received concurrent uterine artery ligation while 2 needed ovarian artery ligation. Despite concurrent procedure 3 patients ended up for hysterectomy (9.1%). The most common indication of caesarean section was placenta previa (51%), mostly done at a gestational age of 37 weeks ± 1.84 standard deviation. Mean age of the patient was 29 years. Estimated blood loss was more than 1.5 litre as seen in 22.6% of the patients and 71.6% patients need blood transfusion. Uterine atony was a common cause of PPH (51%). 51.6% of patients discharged within 3 days of surgery. Two patients expired.

Conclusion:

The innovative suture techniques have shown promise in improving surgical outcomes in resource-constrained environments, especially in developing countries. This effectiveness can help bridge the gap between limited resources and the need for quality surgical care.

Key words: PPH, Uterine Compression Suture, Placenta Previa, Placenta Accreta.